By TCT Daily Staff

Since joining forces 25 years ago to develop guidelines for the use of pacemakers, the American College of Cardiology and American Heart Association have jointly published dozens of evidence-based practice guidelines.

In an interview with TCT TV, Sidney C. Smith, Jr., MD, director of the Center for Cardiovascular Science and Medicine at the University of North Carolina, Chapel Hill, gave a behind-the-scenes look at the guideline process, which he helps oversee.

Together, the AHA and ACC currently sponsor 17 guideline committees, each with 16 to 20 members who serve for three to four years. Depending on the topic, other groups such as the Society for Cardiovascular Angiography and Interventions sometimes co-sponsor the guidelines.

In the past, a committee would meet for just a day, Smith said. Now, the committees get together for two days of intensive review. "We want people who will really be there and turn off [their] phones and e-mail and get the job done," Smith said.

Handling conflicts

Conflict of interest rules have been tightened for committee members in recent years. Members must disclose stock ownership, honoraria, and whether they serve as principle investigator on any studies.

"Someone might have an NIH grant that’s affected by the guidelines," Smith said. "There are intellectual conflicts we need to be aware of, not just monetary [conflicts]." Principle investigators can serve on committes working on guidelines related to the trials they lead; however, they cannot chair them.

A few years ago, the AHA and ACC decided to organize a focus update committee – which revises existing guidelines – without sitting any members who had any potential conflicts of interest. Smith said the experiment was a failure because there was not enough subject-area expertise on the committee.

Now, the AHA and ACC are still learning how to "move away from bias but still have expertise" on the committees, he said.

Problems with guideline adherence

When addressing why more cardiologists do not follow guidelines, Smith pointed to two possible reasons.

First, he said, the AHA and ACC could do a better job of communicating when new guidelines appear. Second, the guidelines often are too long and detailed for physicians to absorb while patients wait. "You can’t leaf through 360 pages on STEMI while a patient is in the ER," he said.

The committees are now working on condensing some guidelines.

"The guidelines I’ve seen used most often are on pacemaker placement – those you can carry around in your pocket," Smith said.

In the near future, increasing use of performance measures by health care systems will probably drive higher adoption of guidelines.

The committees are now considering guidelines on hypertrophic cardiomyopathy and valvular heart disease. Updates for PCI and STEMI should arrive early next year, said Smith.

He encouraged all practitioners to provide feedback. For the first PCI guidelines, the committee sifted through some 1,600 comments. "I would encourage anyone with interest or concern to let us know. We’re interested in making guidelines more useful," he said.

（source：www.tctmd.com）